title: Risk factors for unscheduled delivery in patients with placenta accreta.
abstract: OBJECTIVE
  Patients with suspected placenta accreta have improved outcomes with scheduled delivery. Our objective was to identify risk factors for unscheduled delivery in patients with suspected placenta accreta.
  
  
  METHODS
  This was a cohort study of women with antenatally suspected placenta accreta. Women who delivered prior to a planned delivery date were compared with women who had a scheduled delivery. Data were analyzed using a Student t test, χ(2), logistic regression, and survival analyses. Variables included in the analyses were episodes of antenatal vaginal bleeding, preterm premature rupture of membranes (PPROM), uterine contractions, prior cesarean deliveries, interpregnancy interval, parity, and patient demographic factors. A value of P < .05 was considered significant.
  
  
  RESULTS
  Seventy-seven women with antenatal suspicion for placenta accreta were identified. Thirty-eight (49.4%) had an unscheduled delivery. Demographics were similar between groups. Unscheduled patients delivered earlier (mean 32.3 vs 35.7 weeks, P < .001) and were significantly more likely to have had vaginal bleeding (86.8% vs 35.9%, P < .001) and uterine activity (47.4% vs 2.6%, P < .001). Each episode of antenatal vaginal bleeding was associated with an increased risk of unscheduled delivery (adjusted odds ratio, 3.8; 95% confidence interval, 1.8-7.8). Risk of earlier delivery was even greater when associated with PPROM (P < .001).
  
  
  CONCLUSIONS
  Among women with suspected placenta accreta, those with antenatal vaginal bleeding were more likely to require unscheduled delivery. This risk increases further in the setting of PPROM and/or uterine contractions. These clinical factors should be considered when determining the optimal delivery gestational age for women with placental accreta.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Bowman
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Manuck
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Alexandra G
authors.initials: AG
authors.lastname: Eller
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Marilee
authors.initials: M
authors.lastname: Simons
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D010921:Placenta Accreta / Q000175:diagnosis*; D011247:Pregnancy; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000150:complications*
keywords: placenta accreta; risk factors; unscheduled delivery; vaginal bleeding